1720068737 NPI number — LINDA ANNE KLOSS D.O.

Table of content: KELSIE SCAMP (NPI 1811594484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720068737 NPI number — LINDA ANNE KLOSS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLOSS
Provider First Name:
LINDA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720068737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 782743
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-2743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-910-6887
Provider Business Mailing Address Fax Number:
215-612-5077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1648 HUNTINGDON PIKE
Provider Second Line Business Practice Location Address:
ATTN: RADIOLOGY
Provider Business Practice Location Address City Name:
MEADOWBROOK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19046-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-910-6887
Provider Business Practice Location Address Fax Number:
215-612-5077
Provider Enumeration Date:
01/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OS008286L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X , with the licence number: OS008286L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: OS008286L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25MB08193800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: 25MB08193800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: 25MB08193800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)